The
extent (C0439792)
of
myocardial
viability (C0376314)
in
patients (C0030705)
with
chronic
coronary artery disease (C0010068)
,
previous
myocardial infarction (C0027051)
(
MI (C0026809~C0332288~C0347978)
)
,
and
reduced
left ventricular systolic
function (C0031843~C0205245~C0422812)
has
both
prognostic and therapeutic (C0039796~C0302350)
significance
.
Its
assessment
is
therefore
important
in
the
clinical
treatment (C0039798~C0087111)
of
such
patients (C0030705)
,
especially
when
a
revascularization procedure (C0025664~C0184661)
is
being
considered
.
Myocardial perfusion (C0428857)
scintigraphy
(
MPS
)
is
an
established
method (C0025663~C0025664)
for
the
assessment
of
myocardial
viability (C0376314)
in
the
clinical
setting (C0036849~C0324444)
.
It
is
usually
performed
by
measuring
the
uptake (C0243144~C0347980)
of
thallium-
201
(
which
requires
functional myocardial
cell membranes (C0007603)
)
or
,
less
frequently
,
of
Tc-labeled
agents (C0450442)
such
as
sestamibi
(
which
requires
intact myocardial mitochondrial function (C0031843~C0205245~C0422812)
)
.
Recently , myocardial
contrast echocardiography (C0013518)
(
MCE (C0286540)
)
with
intracoronary
injection (C0021485)
of
microbubbles
has
been
demonstrated
to
be
useful
for
the
assessment
of
myocardial
viability (C0376314)
in
patients (C0030705)
with
both
recent
MI (C0026809~C0332288~C0347978)
and
those
with
poor left ventricular systolic
function (C0031843~C0205245~C0422812)
associated
with
chronic
coronary artery disease (C0010068)
.
The
aim (C0108800)
of
this
study
was
to
compare
perfusion patterns (C0439712~C0449774)
on
MCE (C0286540)
with
those
on
MPS
for
the
assessment
of
myocardial
viability (C0376314)
in
patients (C0030705)
with
chronic
coronary artery disease (C0010068)
and
previous
MI (C0026809~C0332288~C0347978)
.
The
study
was
approved
by
the
Human Investigation (C0430007)
Committee
at
the
University (C0041740)
of
Virginia (C0042753)
,
and
all
patients (C0030705)
gave
written
informed
consent
.
Patients (C0030705)
with
previous
MI (C0026809~C0332288~C0347978)
(
>
6
weeks (C0439230~C0439506)
old
)
who
had
a
corresponding wall motion abnormality (C0000768~C0000769)
on
left (C0205091~C0330089~C0450424)
ventriculography
underwent
MCE (C0286540)
at
the
time (C0040223~C0183941~C0332311~C0392761~C0449243)
of
diagnostic
catheterization (C0007430)
.
Twenty-one
of
these
patients (C0030705)
were
also
referred
by
their
physicians (C0031831)
for
MPS
within
4
weeks (C0439230~C0439506)
of
catheterization (C0007430)
.
These
21
patients (C0030705)
form
the
basis (C0004830~C0178499)
of
this
report (C0178935~C0335038)
,
and
their
clinical (C0205210)
characteristics
are
provided
in
Table (C0039224)
1
.
We
have
previously
described
the
method (C0025663~C0025664)
of
performing
MCE (C0286540)
in
the
cardiac catheterization (C0018795~C0261588)
laboratory
.
In
brief (C0205167~C0453896)
,
sonicated
Renografin- (C0012005)
76
(
Squibb (C0331904)
)
,
which
contains
500,000
+
/-200,000
microbubbles
of
air (C0001861)
with
a
mean
diameter (C0332517)
of
6
um (C0003818~C0180309~C0184514~C0230789~C0324145~C0439104~C0439126~C0439201)
,
was
injected
into
the
left
main (C0205225)
(
1.5
ml (C0439242~C0439526)
)
and
right (C0035621~C0140586~C0205090)
coronary
(
1.0
ml (C0439242~C0439526)
)
arteries (C0003842)
during
simultaneously
performed
transthoracic (C0442386)
two-dimensional echocardiography (C0013524)
in
multiple
views (C0449911)
(
mid-papillary muscle short-axis (C0522488)
and apical four- and (C0205450)
two-chamber views
)
.
In
patients (C0030705)
with
a
totally
occluded
artery (C0003842)
,
contrast patterns (C0439712~C0449774)
within
the
occluded
bed (C0004914~C0004916~C0004922~C0004923~C0005139~C0006030~C0053353~C0205170~C0332272~C0392746~C0439105~C0439127)
were
noted
during
injection (C0021485)
of
the
nonoccluded
arteries (C0003842)
,
which
result
from
collateral
flow (C0330090)
as
described
by
us
previously
.
MPS
was
performed
with
planar tl imaging (C0150628)
in
17
patients (C0030705)
and
Tc-sestamibi
single photon emission (C0233929)
computed
tomography (C0040395)
in
the
remaining
4
.
For
17
patients (C0030705)
3
mCi
of
tl (C0039738)
was
injected
during
exercise (C0015259~C0180776~C0452240)
5
minutes (C0205165~C0439232)
before
the
initial (C0205265)
images
were
obtained
.
The
delayed (C0205421)
images
were
obtained
2
hours (C0439227)
later
.
Images
were
obtained
in
the
anterior
,
45-degree
,
and
70-degree
left anterior
oblique projections (C0442287)
and
were
analyzed
with
a
computer-assisted
approach (C0449445)
.
For
four
patients (C0030705)
8
mCi
of
Tc-sestamibi
was
injected
at
rest (C0035253~C0175724~C0332153~C0332575~C0439117~C0439142)
,
and
images
were
acquired
1
hour (C0439227)
later
.
Exercise (C0015259~C0180776~C0452240)
images
were
acquired
later
in
the
day (C0439228~C0439229~C0439505)
1
hour (C0439227)
after
injection (C0021485)
of
25
to
30
mCi
of
Tc-sestamibi
during
peak exercise (C0015259~C0180776~C0452240)
.
Data
were
processed
with
Ramp (C0034646~C0348053)
and low-pass filters (C0180860~C0402833)
and
back-projection
,
after
which
tomographic images
were
created
in
the
horizontal and vertical long-axis views (C0449911)
.
Quantitative
measurements (C0242485)
were
then
performed
in
different myocardial
regions (C0205147~C0446452)
.
Only
the
delayed planar
tl (C0039738)
and
the
rest (C0035253~C0175724~C0332153~C0332575~C0439117~C0439142)
Tc-sestamibi images
were
analyzed
for
this
study
.
The
left ventricle (C0225897)
was
divided
into
five
regions (C0205147~C0446452)
for
both
forms (C0205431~C0348078~C0376315~C0426412)
of
imaging (C0150628)
:
apex (C0225409)
and interventricular septum (C0225870)
and
lateral
,
inferior
,
and
anterior walls (C0442070)
.
Each
region (C0205147~C0446452)
was
evaluated
by
two
observers
on
MCE (C0286540)
and
MPS
.
Similar
scores (C0449820)
were
used
for
both
methods (C0025663~C0025664)
of
imaging (C0150628)
:
0
=
no
opacification (C0449584)
on
MCE (C0286540)
and
severe
defect (C0243067~C0332451)
(
<
50
%
of
maximal
counts (C0076112~C0439157)
)
on
MPS
;
0.5
=
partial or patchy
opacification (C0449584)
(
including
that
seen
only
in
the
epicardial (C0442016)
rim
)
on
MCE (C0286540)
and
mild
to
moderate
defect (C0243067~C0332451)
(
25
%
to
50
%
of
maximal
counts (C0076112~C0439157)
)
on
MPS
;
and
1
=
homogeneous
opacification (C0449584)
on
MCE (C0286540)
and
normal
uptake (C0243144~C0347980)
on
MPS
.
The
interobserver and intraobserver errors
for
MCE (C0286540)
and
MPS
are
small
and
have
been
previously
reported
.
Each
region (C0205147~C0446452)
was
also
graded
for
wall motion (C0026597)
as
follows
:
1
=
normal (C0205307~C0439166)
,
2
=
mild
hypokinesia (C0086439)
,
3
=
severe
hypokinesia (C0086439)
,
4
=
akinesia (C0085623)
,
and
5
=
dyskinesia (C0013384)
.
Our
interobserver and intraobserver errors
for
wall motion score (C0449820)
calculation
are
also
small
and
have
been
previously
reported
.
The
wall motion scores (C0449820)
were
assigned
while
the
observers
were
blinded
to
the
MCE (C0286540)
and MPS data
.
All
data
were
analyzed
with
RS (C0035253~C0175724~C0332153~C0332575~C0439117~C0439142)
/
1
(
Bolt (C0336726)
,
Beranek
,
and
Newman
)
.
A
weighted kappa statistic (C0038215~C0220917)
was
used
to
assess
concordance
between
MCE (C0286540)
and
MPS
.
The
weight (C0005910~C0043100)
favored
fewer
and
penalized
greater (C0205164~C0443228)
differences
in
scores (C0449820)
between
the
methods (C0025663~C0025664)
.
Correlations
between
scores (C0449820)
were
performed
with
Spearman
's
rank
statistic (C0038215~C0220917)
.
Ninety-one
of
the
105
ventricular
regions (C0205147~C0446452)
were
visualized
by
both
techniques (C0025664~C0449851)
.
Of
the
14
regions (C0205147~C0446452)
not
visualized
,
10
were
because
of
inadequate
MCE (C0286540)
images
where
the
interventricular septum (C0225870)
was
not
seen
in
4
,
the
lateral
wall (C0205380)
in
3
,
the
anterior wall (C0442070)
in
2
,
and
the
apex (C0225409)
in
1
.
Four
regions (C0205147~C0446452)
were
not
well
seen
on
MPS
and
included
the
interventricular septum (C0225870)
in
two
and
the
lateral and anterior walls (C0442070)
each
in
one
.
Fig (C0349966)
.
1
illustrates
the
concordance
between
the
two
tests (C0039593~C0039597~C0076174~C0154007~C0183885~C0392366~C0430738~C0496924)
.
In
the
91
regions (C0205147~C0446452)
visualized
by
both
techniques (C0025664~C0449851)
,
complete (C0205197)
concordance
was
noted
in
63
(
69
%
)
between
the
two
methods (C0025663~C0025664)
;
25
regions (C0205147~C0446452)
(
27
%
)
were
discordant
by
only
1
grade (C0441800~C0449383~C0456748)
,
and
complete (C0205197)
discordance
(
2
grades (C0441800~C0449383~C0456748)
)
was
found
in
only
three
(
3
%
)
regions (C0205147~C0446452)
.
A
kappa statistic (C0038215~C0220917)
of
0.65
indicated
good (C0004914~C0004916~C0004922~C0004923~C0005139~C0006030~C0053353~C0205170~C0332272~C0392746~C0439105~C0439127)
concordance
between
the
two
techniques (C0025664~C0449851)
.
Fig (C0349966)
.
2
is
an
example
of
concordance
between
the
two
techniques (C0025664~C0449851)
and
demonstrates
an
inferoapical
defect (C0243067~C0332451)
in
a
patient (C0030705)
with
previous inferior
MI (C0026809~C0332288~C0347978)
.
Although
planar
201Tl
shows (C0150769)
overall low counts (C0076112~C0439157)
in
the
inferior
wall (C0205380)
,
the
MCE (C0286540)
image
shows
opacification (C0449584)
limited
only
to
the
epicardial (C0442016)
rim
,
with
none
seen
in
the
rest (C0035253~C0175724~C0332153~C0332575~C0439117~C0439142)
of
the
myocardium (C0027061)
.
The
inferior
wall (C0205380)
received
a
score (C0449820)
of
0.5
by
both
techniques (C0025664~C0449851)
.
In
16
regions (C0205147~C0446452)
the
MCE score (C0449820)
was
higher
than
the
score (C0449820)
on
MPS
,
whereas
in
12
regions (C0205147~C0446452)
the
converse
occurred
.
Most
of
the
discordance
occurred
by
1
grade (C0441800~C0449383~C0456748)
.
The
three
regions (C0205147~C0446452)
with
complete (C0205197)
discordance
(
>
1
grade (C0441800~C0449383~C0456748)
)
included
a
lateral wall defect (C0243067~C0332451)
seen
on
MPS
but
not
on
MCE (C0286540)
and
two
apical
defects (C0243067~C0332451)
noted
on
MCE (C0286540)
but
not
on
MPS
.
Thus
discordance
was
noted
in
only
3
of
the
21
patients (C0030705)
.
An
example
of
complete (C0205197)
discordance
between
the
two
techniques (C0025664~C0449851)
is
depicted
in
Fig (C0349966)
.
3
in
a
patient (C0030705)
with
a
previous anteroapical MI (C0026809~C0332288~C0347978)
.
A
large perfusion defect (C0243067~C0332451)
is
seen
in
the
apex (C0225409)
on
MCE (C0286540)
,
and
no
such
defect (C0243067~C0332451)
is
seen
in
the
apex (C0225409)
on
planar
201Tl
imaging (C0150628)
.
Although
the
201Tl
data
are
shown
only
in
the
45-degree
left anterior
oblique projection (C0442287)
,
other
projections (C0033363~C0348018)
also
did
not
show
a
perfusion defect (C0243067~C0332451)
in
the
apex (C0225409)
.
Although
the
scores (C0449820)
on
both
MCE (C0286540)
and
MPS
showed
a
correlation
with
wall motion score (C0449820)
(
Fig (C0349966)
.
4
)
,
the
correlation
between
the
MCE (C0286540)
and
wall
motion scores (C0449820)
was
closer
(
p (C0016504~C0033452~C0036421~C0078414~C0439115~C0439140~C0449201~C0487890)
=
0.63
vs
p (C0016504~C0033452~C0036421~C0078414~C0439115~C0439140~C0449201~C0487890)
=
0.50
,
p (C0016504~C0033452~C0036421~C0078414~C0439115~C0439140~C0449201~C0487890)
=
0.05
)
.
Our
study
demonstrates
that
in
patients (C0030705)
with
previous
MI (C0026809~C0332288~C0347978)
,
MCE (C0286540)
provides
similar information
regarding
viability (C0376314)
as
MPS
,
a
more established
method (C0025663~C0025664)
.
These
findings (C0243095~C0263541~C0332285)
potentially
broaden
the
role (C0035820)
of
this
technique (C0025664~C0449851)
for
the
assessment
of
myocardial
viability (C0376314)
in
the
cardiac catheterization (C0018795~C0261588)
laboratory
.
The
delayed
201tl
image
reflects
the
amount (C0205389)
of
201Tl
sequestered
in
the
myocardium (C0027061)
.
Because
201Tl
enters
the
myocytes
mostly
by
way
of
the
Na/K pump (C0182537)
,
its
presence (C0392148~C0392743)
within
the
myocardium (C0027061)
indicates
that
the
cell membrane (C0007603)
is
intact
.
Similarly
,
at
rest (C0035253~C0175724~C0332153~C0332575~C0439117~C0439142)
,
Tc-sestamibi
diffuses
into
the
extravascular
space (C0221874)
and
passively
enters
the
myocyte
before
binding
to
the
negatively
charged
mitochondrial membrane (C0025255)
.
Consequently
,
its
retention (C0035280~C0333117)
within
the
myocyte
is
dependent
on
intact mitochondrial function (C0031843~C0205245~C0422812)
.
The
relative
activity (C0439167~C0441655)
of
both
tracers (C0442822)
therefore
provides
an
approximate (C0332232)
estimate
of
the
number (C0237753~C0449788)
of
myocytes
that
are
viable
within
a
region (C0205147~C0446452)
.
In
comparison
,
microbubbles
used
for
MCE (C0286540)
reside
entirely
within
the
vascular
space (C0221874)
.
They
do
not
enter
the
extravascular
space (C0221874)
,
nor
are
they
extracted
by
myocytes
.
They
do
not
enter
regions (C0205147~C0446452)
where
microvessels
are
absent
such
as
in
scar tissue (C0008767)
.
Microbubbles
are
also
not
seen
in
regions (C0205147~C0446452)
with
other
forms (C0205431~C0348078~C0376315~C0426412)
of
microvascular
disruption (C0332453)
,
plugging
,
and
obliteration (C0332465~C0391855)
,
which
is
frequently
noted
in
areas (C0205146)
with
infarction (C0021308)
.
The
high
degree (C0439489~C0449286)
of
concordance
between
MCE (C0286540)
and
MPS
should
therefore
not
be
surprising
and
has
also
been
found
in
studies
with
venous
injections (C0021485)
of
microbubbles
.
Mild (C0205080)
differences
in
score (C0449820)
(
1
grade (C0441800~C0449383~C0456748)
)
noted
in
our
study
can
be
explained
on
the
different
methods (C0025663~C0025664)
of
image representation
(
tomographic
vs
planar
)
.
Although
complete (C0205197)
discordance
between
the
two
techniques (C0025664~C0449851)
was
exceptional
,
it
could
be
most
dramatic
as
in
the
example
shown
in
Fig (C0349966)
.
3
.
There
are
several possible
reasons (C0392360)
for
this
discordance
.
Although
no
clinically
documented
events (C0441471)
occurred
between
cardiac catheterization (C0018795~C0261588)
and
MPS
,
there
is
a
small
chance (C0237506)
that
a
new
MI (C0026809~C0332288~C0347978)
could
have
occurred
.
The
likelihood
of
an
artifact (C0085089)
on
MCE (C0286540)
is
small
,
particularly
if
it
encompasses
the
entire
apex (C0225409)
.
It
is
possible
that
the
microvasculature (C0243079)
within
the
apex (C0225409)
was
so
sparse
as
not
to
be
detected
on
MCE (C0286540)
.
The
low
level (C0441889~C0456079)
of
myocardial perfusion (C0428857)
may
,
however
,
still
have
allowed
accumulation
of
201Tl
over
several
hours (C0439227)
within
viable
myocardium (C0027061)
.
Thus
unless
very low (C0442811)
levels
of
flow (C0330090)
are
detectable
on
MCE (C0286540)
,
an
extractable
tracer (C0442822)
may
have
an
advantage (C0308269)
in
terms
of
assessing
myocardial
viability (C0376314)
.
It
is
likely
,
however
,
that
more sensitive
methods (C0025663~C0025664)
of
detecting
the
presence (C0392148~C0392743)
of
microbubbles
in
tissue (C0040300)
such
as
intermittent harmonic
imaging (C0150628)
will
make
it
possible
to
measure
low
levels (C0441889~C0456079)
of
flow (C0330090)
on
MCE (C0286540)
.
Microbubbles
are
destroyed
on
ultrasound
exposure (C0274281~C0332157~C0391838)
.
During
the
process
of
destruction (C0185043~C0240548)
,
they
produce
an
"
acoustic
noise (C0028263)
,
"
which
contains
many
frequencies (C0042023~C0376249~C0439603)
including
the
frequency (C0042023~C0376249~C0439603)
to
which
they
were
exposed
(
fundamental
frequency (C0042023~C0376249~C0439603)
)
.
Selective acquisition
of
the
nonfundamental
frequencies (C0042023~C0376249~C0439603)
(
including
harmonics
of
the
fundamental
frequency (C0042023~C0376249~C0439603)
)
results
in
increased signal-to-noise ratio (C0456603)
and
better
imaging (C0150628)
of
the
microbubbles
.
The
signal-to-noise ratio (C0456603)
is
further
increased
when microbubble
destruction (C0185043~C0240548)
is
minimized
by
obtaining
images
intermittently
rather
than
continuously
.
Experimental data
from
our
laboratory (C0022877)
indicate
that
this
method (C0025663~C0025664)
can
be
used
to
measure
very low (C0442811)
levels
of
flow (C0330090)
.
In
the
cardiac catheterization (C0018795~C0261588)
laboratory MCE
offers
a
practical
advantage (C0308269)
over
other
techniques (C0025664~C0449851)
in
that
it
can
provide
more immediate
viability (C0376314)
assessment
,
which
can
then
be
used
to
guide
clinical decision making (C0150516)
and
obviate
the
need (C0027552~C0028158~C0332125~C0347979~C0439138~C0439225~C0441922)
for
a
noninvasive viability test (C0039593~C0039597~C0076174~C0154007~C0183885~C0392366~C0430738~C0496924)
done
on
another
day (C0439228~C0439229~C0439505)
,
which
can
increase
hospital (C0019994)
stay
and
cost (C0010186~C0220812)
.
Because
of
its
superior (C0205105)
spatial resolution
,
MCE (C0286540)
can
define
the
transmural
location (C0450429)
of
viable
tissue (C0040300)
,
which
can
have
prognostic implications
.
For
instance
,
in
Fig (C0349966)
.
2
both
techniques (C0025664~C0449851)
demonstrated
partial
viability (C0376314)
.
However
,
on
MCE (C0286540)
it
is
clear
that
opacification (C0449584)
is
limited
only
in
the
epicardial (C0442016)
rim
.
Because
wall thickening (C0205400~C0332527)
is
dependent
on
endocardial
viability (C0376314)
,
this
patient (C0030705)
is
unlikely
to
demonstrate
improvement
in
regional
function (C0031843~C0205245~C0422812)
after
revascularization
.
The
201Tl
image
does
not
provide
this
potentially important information
because
it
cannot
distinguish
between
reduced
perfusion (C0031001)
caused
by
low
flow (C0330090)
from
that
caused
by
partial
MI (C0026809~C0332288~C0347978)
.
Except
for
four
patients (C0030705)
,
the
MPS data
were
not
tomographic
.
Data
registration
between
the
two
techniques (C0025664~C0449851)
was
therefore
not
optimal
.
It
is
for
this
reason (C0392360)
that
we
reduced
the
data
to
regions (C0205147~C0446452)
of
the
left ventricular myocardium (C0027061)
instead
of
comparing
segments (C0442060)
to
each
other (C0205394~C0220886~C0237094~C0237098~C0237111~C0237120~C0237127~C0237133~C0237142~C0237155~C0237161~C0237162~C0237169~C0237173~C0237178~C0237185~C0237190~C0237195~C0237206~C0237212~C0237221~C0237228~C0237237~C0237242~C0237243~C0237247~C0237255~C0237262~C0237266~C0237276~C0237283~C0237285~C0237289~C0237300~C0237305~C0237318~C0237324~C0237330~C0237338~C0237343~C0237344~C0237353~C0237357~C0237361~C0237366~C0237369~C0237373~C0237380~C0237387~C0237394~C0237395~C0449210)
.
This
approach (C0449445)
,
however
,
did
not
detract
from
the
way
we
would
have
read
each
study
clinically
.
Despite
the
use (C0042153~C0439224~C0449865)
of
two
different
isotopes (C0022262)
,
no
differences
were
seen
in
the
results (C0332294)
,
although
the
number (C0237753~C0449788)
of
patients (C0030705)
studied
was
small
.
We
did
not
perform
a
revascularization procedure (C0025664~C0184661)
to
determine
which
method (C0025663~C0025664)
predicts
recovery (C0237820)
in
function (C0031843~C0205245~C0422812)
.
Revascularization
was
not
clinically
indicated
in
many
of
these
patients (C0030705)
,
and
follow-up
studies
were
not
performed
in
those
who
received
such
a
procedure (C0025664~C0184661)
.
We
and
others (C0205394~C0220886~C0237094~C0237098~C0237111~C0237120~C0237127~C0237133~C0237142~C0237155~C0237161~C0237162~C0237169~C0237173~C0237178~C0237185~C0237190~C0237195~C0237206~C0237212~C0237221~C0237228~C0237237~C0237242~C0237243~C0237247~C0237255~C0237262~C0237266~C0237276~C0237283~C0237285~C0237289~C0237300~C0237305~C0237318~C0237324~C0237330~C0237338~C0237343~C0237344~C0237353~C0237357~C0237361~C0237366~C0237369~C0237373~C0237380~C0237387~C0237394~C0237395~C0449210)
have
demonstrated
the
predictive
value (C0042295~C0401806)
of
both
techniques (C0025664~C0449851)
for
improvement
of
regional
function (C0031843~C0205245~C0422812)
after
revascularization
in
similar kinds
of
patients (C0030705)
.
This
is
the
first (C0205435)
study
,
however
,
that
compares
the
results (C0332294)
of
the
two
techniques (C0025664~C0449851)
in
the
same
patients (C0030705)
.
This
study
was
performed
in
the
cardiac catheterization (C0018795~C0261588)
laboratory
with
selective coronary
injections (C0021485)
.
Recent (C0332185)
experimental data
indicate
that
similar
results (C0332294)
can
be
obtained
with
aortic root (C0489673)
injections
when intermittent harmonic
imaging (C0150628)
is
used
,
which
will
make
the
technique (C0025664~C0449851)
easier
and
simpler
to
perform
.
MCE (C0286540)
provides
similar information
as
MPS
for
the
putative assessment
of
myocardial
viability (C0376314)
in
patients (C0030705)
with
coronary artery disease (C0010068)
and
old
MI (C0026809~C0332288~C0347978)
.
We
and
others (C0205394~C0220886~C0237094~C0237098~C0237111~C0237120~C0237127~C0237133~C0237142~C0237155~C0237161~C0237162~C0237169~C0237173~C0237178~C0237185~C0237190~C0237195~C0237206~C0237212~C0237221~C0237228~C0237237~C0237242~C0237243~C0237247~C0237255~C0237262~C0237266~C0237276~C0237283~C0237285~C0237289~C0237300~C0237305~C0237318~C0237324~C0237330~C0237338~C0237343~C0237344~C0237353~C0237357~C0237361~C0237366~C0237369~C0237373~C0237380~C0237387~C0237394~C0237395~C0449210)
have
previously
demonstrated
similar
results (C0332294)
in
patients (C0030705)
with
recent
MI (C0026809~C0332288~C0347978)
.
These
findings (C0243095~C0263541~C0332285)
potentially
broaden
the
role (C0035820)
of
this
technique (C0025664~C0449851)
for
the
assessment
of
myocardial
viability (C0376314)
in
the
cardiac catheterization (C0018795~C0261588)
laboratory
.
Presented
in
part (C0332285~C0449719)
at
the
Seventh Annual (C0332181)
Scientific Session
of
the
American Society (C0037455)
of
Echocardiography (C0013516)
,
Chicago (C0008044)
,
Ill (C0105122~C0205169~C0332271)
.
,
June
10-12
,
1996
.
Reprint requests
:
Michael Ragosta
,
MD
,
Cardiovascular Division (C0441531)
,
Box (C0006080~C0179400)
158
,
Medical Center (C0205099)
,
University (C0041740)
of
Virginia (C0042753)
,
Charlottesville
,
VA
22908
.